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Evaluating Medication Coverage Policies and Access to Medicines among Vulnerable Populations
Alyce Adams
Prescription drugs are key weapons in the fight against acute and chronic disease. As cost is a key barrier to medication access and adherence among vulnerable populations, restrictions in medication coverage have the potential to increase health disparities. Drug Policy Research Group investigators, including Stephen Soumerai, Dennis Ross-Degnan, Alyce Adams, and Fang Zhang, are conducting several studies that examine the impact of medication coverage and changes in coverage policies on medication use and associated health outcomes among minorities, disabled, chronically ill, and the elderly. Policy makers nationwide have used earlier findings from the group's studies to improve access to medicines among Medicaid and Medicare beneficiaries. Future studies will examine the impact of the new Medicare Part D coverage policy on disparities in medication access and use.
Parent Asthma Communication Experiences (PACE) Project - Finding ways to improve effective medication use by children in diverse populations
Tracy Lieu
The Parent Asthma Communication Experiences Project is studying why children with persistent asthma often underuse controller medications. The project was prompted by earlier studies by DACP investigators that found that most children with persistent asthma were not using controller medications every day as recommended by national guidelines. In addition, African-American and Latino children with asthma were less likely to be on daily controller medications than white children even after adjusting for socioeconomic status and disease severity. The PACE Project, supported by the National Institute for Child Health and Human Development, uses qualitative and quantitative survey methods to find the reasons for controller medication non-adherence among a diverse group of children in the Harvard Vanguard Medical Associates (HVMA) and Neighborhood Health Plan (NHP) populations. The survey phase has enrolled more than 700 children, interviewed their parents, and surveyed their providers. The project is led by Dr. Tracy Lieu; collaborators include Dr. Alison Galbraith, Drs. Barbara Bokhour, Ellen Cohn, and Lauren Smith of Boston University, and Dr. Dharma Cortes of Cambridge Health Alliance, Dr. Cindy Rand of Johns Hopkins University, Dr. Jack Lasche of HVMA, and Dr. Jim Glauber of NHP.
Reducing Disparities in Chronic Illness Care, Self-Management and Outcomes:
Alyce Adams
Individuals belonging to racial and ethnic minorities are more likely to develop certain chronic diseases (e.g., diabetes, hypertension), but are less likely to receive or engage in appropriate care. Previous studies suggest that racial differences in health care are due in part to a segregated health care system in which minority patients have lower access to high quality care, but few data are available from managed care settings where differences in quality of care are minimized. In a study of medical record and claims data spanning 10 years, investigators in the Drug Policy Research Group Dennis Ross-Degnan, Stephen Soumerai, Alyce Adams, Connie Mah and Fang Zhang, are examining the complex relationships between race, self-management, glycemic control, and long term outcomes among adult patients at Harvard Vanguard Medical Associates (HVMA) who are insured by Harvard Pilgrim Health Care (HPHC). The group found persistent racial differences in self-care and outcomes, even though blacks and whites had equal access to high quality care. These findings will lead to focused interventions to improve the quality of care for minority and non-English speaking patients with chronic illness.
Click here for citation and abstract of article in Diabetes Care
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